{block name=checkout-login}
<form class="form-horizontal" id="checkout2-form" role="form" accept-charset="UTF-8" action="" method="post">
    <input type="hidden" value="checkout2" name="action" />
    <div class="checkform">
        <h2 class="title">请检查/添加您的个人信息</h2>
        <div class="checkout-shipping" id="enroltrialmain">
            <div class="row">
                <div class="col-sm-8 col-sm-offset-2">
                    <div class="row">
                        <div class="col-sm-6 form-group">
                            <label for="gname">{$lang.contact.name}</label>
                            <input id="namesh" value="{if $address && $address.S.address_name}{$address.S.address_name}{if $address.S.address_surname} {$address.S.address_surname}{/if}{else}{$user.gname} {$user.surname}{/if}" name="address[S][address_name]" type="text" required="required" />
                        </div>
                        <div class="col-sm-6 form-group">
                            <label for="phonesh">{$lang.contact.phone}</label>
                            <input id="phonesh" value="{if $address}{$address.S.address_telephone}{/if}" name="address[S][address_telephone]" type="text" required="required" />
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-sm-3 form-group">
                            <label for="state">{$lang.contact.province}</label>
                            <select id="state" name="address[S][address_state]" class="shipping-select-req required form-control">
                                {foreach $options_state as $opt }
                                <option value="{$opt.value}" {if $address && $address.S.address_state eq $opt.value}selected="selected"{/if}>{$opt.value}</option>
                                {/foreach}
                            </select>
                        </div>
                        <div class="col-sm-3 form-group">
                            <label for="suburb">{$lang.contact.city}</label>
                            <select id="suburb" name="address[S][address_suburb]" class="shipping-select-req required form-control">
                                <option value="">请选择</option>
                                {foreach $options_suburb as $opt }
                                <option value="{$opt.value}" {if $address && $address.S.address_suburb eq $opt.value}selected="selected" {/if}>{$opt.value}</option>
                                {/foreach}
                            </select>
                        </div>
                        <div class="col-sm-6 form-group">
                            <label for="country">{$lang.contact.country}</label>
                            <select id="country" name="address[S][address_country]" class="shipping-select-req required form-control">
                                <option value="">请选择</option>
                            </select>
                        </div>
                    </div>
                    <div class="row">
                        <div class="col-sm-6 form-group">
                            <label for="streetsh">{$lang.contact.street_no}</label>
                            <input id="streetsh" value="{if $address}{$address.S.address_line1}{/if}" name="address[S][address_line1]" type="text" required="required" />
                        </div>
                        <div class="col-sm-6 form-group">
                            <label for="postcodesh">{$lang.contact.postcode}</label>
                            <input id="postcodesh" value="{if $address}{$address.S.address_postcode}{/if}" name="address[S][address_postcode]" pattern="[0-9]" type="text"/>
                            <!-- <p class="small">Please note we cannot ship to PO boxes</p> -->
                        </div>
                        <!--      <div class="form-group">
        <div class="col-sm-12">
          <input id="country" placeholder="Country*" value="{if $address}{$address.S.country}{/if}" name="address[S][country]" type="text" class="form-control" required="required"  />
          </div>
        </div> -->
                    </div>
                    <!--  <div class="row"> 
          <div class="col-sm-12">
            <label for="comments">Shipping instructions:</label>
          </div>
          <div class="col-sm-12">
            <textarea id="text" name="comments" id="text" maxlength="128">{if $comments}{$comments}{/if}</textarea>
          </div>
      </div> -->
                </div>
            </div>
        </div>
    </div>
    <div class="checkform">
        <div class="col-sm-12">
            <div class="row hidden">
                <div class="form-group">
                    <div class="row">
                        <div class="col-sm-12">
                            <div class="cbout">
                                <input id="promo1" name="address[wantpromo]" type="checkbox" checked="checked" />
                                <label for="promo1" class="chklab">请邮件发送给我以后的宣传资料。</label>
                            </div>
                        </div>
                    </div>
                </div>
                <div class="form-group">
                    <div class="row">
                        <div class="col-sm-12">
                            <div class="cbout">
                                <input type="checkbox" id="accept" name="accept" checked="checked" required>
                                <label for="accept" class="chklab">
                                    我接受 <a href="/privacy-policy" target="_blank">隐私政策</a>, <a href="/shipping-and-delivery" target="_blank">发货政策</a>, <a href="/returns-policy" target="_blank">退款政策</a> 以及 <a href="/terms-and-conditions" target="_blank">条款和条件</a>.
                                </label>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</form>
<div class="col-sm-12">
    <div class="error-textbox" id="error-text1"></div>
</div>
<div class="row">
    <div class="col-sm-2 col-sm-offset-10 text-right">
        <button type="button" class="enquire" onclick="$('#checkout2-form').submit();">继续</button>
    </div>
</div>
<br />
<br />
{/block}